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Greater tuberosity medial malposition: does it affect shoulder abductor moment?

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Abstract

Purpose

The detrimental effect of greater tuberosity malposition on functional scores is well known. Superior or posterior malpositions exceeding five mm lead to excessive loading on the deltoid strength. However, the significance of situations where greater tuberosity becomes medialized due to the compressive effect of the locking plate fixation, especially in fractures with metaphyseal dead space, has not been emphasized. It is hypothesized that this condition may cause shortening of the rotator cuff moment arm and consequently impact functional scores.

Methods

Between 2012 and 2018, 52 patients, aged 65,28 (ranging 40-85) proximal humerus fractures treated with locking plate fixation were included in the study. Cephalodiaphyseal angle, greater tuberosity displacement , patients reported outcome and Constant-Murley scores were evaluated.

Results

The mean Constant Murley score was determined to be 78.76 (ranging from 38 to 100). According to the patients reported outcome 39 excellent , five good , two fair, six poor results were observed. Avascular necrosis with screw migration was detected in five cases, while one patient experienced implant insufficiency along with varus deformity. Greater tuberosity was found to be positioned between 6 mm posterior-superior and -13 mm medial. Significant medial malposition was observed in three patients, with -9, -12, and -13 mm of medialization, respectively. Cephalodiaphysial angle was determined as 139.30 degrees (ranging from 120 to 150 degrees) and showed weak correlation with the functional score. Greater tuberosity medialization also showed weak correlation with the Constant-Murley score. The values exhibiting deviation were associated with low patient-reported outcome results and functional scores. In the examination of greater tuberosity displacement values, it was observed that Neer type 3 and 4 fractures differed significantly from Neer type 2 fractures regarding to Kruskal-Wallis test.

Conclusions

Medial impaction of greater tuberosity may be the reason of decreased functional scores, similar to superior or posterior malposition. The medialization of greater tuberosity should be considered as a potential factor leading to the shortening of the rotator cuff's abductor moment.

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Data availability

The authors declare that data and materials of study are available.

Statistical analysis of study was prepared by MedCalc Software (Belgium 1993-2016)

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose.

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Authors and Affiliations

  1. Physiotheraphy and Rehabilitation Department, T.C. Istanbul Yeni Yüzyıl University Faculty of Health Sciences, Maltepe Mahallesi, Yılanlı Ayazma Caddesi, No: 26 P.K. 34010 Cevizlibağ, Zeytinburnu, İstanbul, Turkey

    Taner Bekmezci

  2. Orthopaedics and Traumatology Department, University of Health Sciences Istanbul Umraniye Training and Research Hospital, Elmalıkent Mahallesi Adem Yavuz Cad. No:1 Ümraniye, İstanbul, Turkey

    Serdar Kamil Çepni

  3. Orthopaedics and Traumatology Department, Giresun University Faculty of Medicine, Gazipaşa Yerleşkesi Debboy Mevkii P.K.:28200 Merkez, Giresun, Turkey

    Tuğcan Demir

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Taner Bekmezci, Serdar Kamil Cepni and Tugcan Demir. The first draft of the manuscript was written by Taner Bekmezci and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Taner Bekmezci.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Umraniye Training and Research Hospital Clinical Researches Ethics Committee (Date: May 29 2023, Decision No: E-54132726-000-216514878).

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Informed consent was obtained from all individual participants included in the study.

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Bekmezci, T., Çepni, S.K. & Demir, T. Greater tuberosity medial malposition: does it affect shoulder abductor moment?. International Orthopaedics (SICOT) 48, 159–167 (2024). https://doi.org/10.1007/s00264-023-05967-8

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